Sheppard Caroline E, Lester Erica L W, Chuck Anderson W, Kim David H, Karmali Shahzeer, de Gara Christopher J, Birch Daniel W
Faculty of Medicine & Dentistry, Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada.
Surg Endosc. 2014 Dec;28(12):3329-36. doi: 10.1007/s00464-014-3613-8. Epub 2014 Jun 27.
The objective of this study was to determine the short-term cost impact that medical tourism for bariatric surgery has on a public healthcare system. Due to long wait times for bariatric surgery services, Canadians are venturing to private clinics in other provinces/countries. Postoperative care in this population not only burdens the provincial health system with intervention costs required for complicated patients, but may also impact resources allotted to patients in the public clinic.
A chart review was performed from January 2009 to June 2013, which identified 62 medical tourists requiring costly interventions related to bariatric surgery. Secondarily, a survey was conducted to estimate the frequency of bariatric medical tourists presenting to general surgeons in Alberta, necessary interventions, and associated costs. A threshold analysis was used to compare costs of medical tourism to those from our institution.
A conservative cost estimate of $1.8 million CAD was calculated for all interventions in 62 medical tourists. The survey established that 25 Albertan general surgeons consulted 59 medical tourists per year: a cost of approximately $1 million CAD. Medical tourism was calculated to require a complication rate ≤ 28% (average intervention cost of $37,000 per patient) to equate the cost of locally conducted surgery: a rate less than the current supported evidence. Conducting 250 primary bariatric surgeries in Alberta is approximately $1.9 million less than the modeled cost of treating 250 medical tourists returning to Alberta.
Medical tourism has a substantial impact on healthcare costs in Alberta. When compared to bariatric medical tourists, the complication rate for locally conducted surgery is less, and the cost of managing the complications is also much less. Therefore, we conclude that it is a better use of resources to conduct bariatric surgery for Albertan residents in Alberta than to fund patients to seek surgery out of province/country.
本研究的目的是确定减肥手术医疗旅游对公共医疗系统的短期成本影响。由于减肥手术服务的等待时间较长，加拿大人开始前往其他省份/国家的私人诊所。这群患者的术后护理不仅给省级卫生系统带来了复杂患者所需干预成本的负担，还可能影响分配给公立诊所患者的资源。
对2009年1月至2013年6月期间的病历进行回顾，确定了62名需要与减肥手术相关的昂贵干预措施的医疗游客。其次，进行了一项调查，以估计艾伯塔省普通外科医生接待的减肥医疗游客的频率、必要的干预措施和相关成本。使用阈值分析将医疗旅游的成本与我们机构的成本进行比较。
对62名医疗游客的所有干预措施进行保守成本估计，为180万加元。调查确定，25名艾伯塔省普通外科医生每年接待59名医疗游客：成本约为100万加元。经计算，医疗旅游的并发症发生率≤28%（每位患者平均干预成本为37,000加元）时，成本才能等同于在当地进行手术的成本：这一发生率低于目前支持的证据。在艾伯塔省进行250例原发性减肥手术的成本比治疗250名返回艾伯塔省的医疗游客的模拟成本约低190万加元。
医疗旅游对艾伯塔省的医疗成本有重大影响。与减肥医疗游客相比，在当地进行手术的并发症发生率更低，管理并发症的成本也更低。因此，我们得出结论，为艾伯塔省居民在艾伯塔省进行减肥手术比资助患者到省外/国外寻求手术更能有效利用资源。
